Healthcare Provider Details

I. General information

NPI: 1326388430
Provider Name (Legal Business Name): KELLY ELIZABETH TAYLOR ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY COLEMAN COLEMAN ANP

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 AUSTIN DR
DEMOREST GA
30535-4513
US

IV. Provider business mailing address

PO BOX 658
GAINESVILLE GA
30503-0658
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-8518
  • Fax: 706-754-6238
Mailing address:
  • Phone: 770-718-1122
  • Fax: 770-533-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN184594
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN184594
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: